New data from researchers in Denmark suggest that children who have a lot of common infections early in life have higher risk of moderate to severe infections and antibiotic use throughout childhood.
The findings are from a study, published today in JAMA Network Open, that analyzed data on common infection episodes and antibiotic prescriptions in a cohort of Danish children from birth to age 10 or 13 years. Researchers with the University of Copenhagen found that children with a high versus low burden of infection between birth and 3 years of age were more likely to have moderate to severe infections and to receive antibiotic treatment by ages 10 and 13.
The researchers say the findings are useful for the prognosis and follow-up of young children who have a high burden of infection.
High versus low infection burden
Using data from the Danish population-based Copenhagen Prospective Studies on Asthma in Childhood (COPSAC) birth cohort, the researchers analyzed daily symptom and medication diaries completed by parents of children ages 0 to 3 years, supported by both scheduled and acute visits to the COPSAC clinic. Infections of interest included colds, gastroenteritis, fever episodes, acute otitis media (earache), tonsilitis, and pneumonia.
The researchers then examined data on diagnoses and prescriptions at scheduled clinical visits until February 2024, when the children had reached the age 10- or 13-year planned clinical visit. The incidence of moderate to severe infections and systemic antibiotics after age 3 was estimated using adjusted incidence rate ratios (AIRRs). The analysis was adjusted for social and environmental confounders, including sex, social circumstances, delivery mode, and maternal age, education and income.
Of the 700 children included in the study, 614 had daily diary infection data from birth to 3 years available. Among these children, there was a mean of 16.4 infections, with colds the most frequent infection identified. After age 3, the 614 children experienced 268 moderate to severe infections, primarily pneumonia (77.6%), with a mean of 2.32 antibiotic treatments per child.
This longitudinal cohort study suggests that early-life infection burden may continue throughout childhood and is associated with later antibiotic treatments independent of social and environmental risk factors.
When the researchers compared children who'd had 16 or more infections by age 3 (high burden) with those who'd had 15 or fewer (low burden), they found a more than twofold higher risk of moderate to severe infection after age 3 in the high-burden group (181 vs 87 episodes; AIRR, 2.39; 95% confidence interval [CI], 1.52 to 3.89] and an increased risk of systemic antibiotic treatments (799 vs 632 episodes; AIRR, 1.34; 95% CI, 1.07 to 1.68).
The analysis also found that, even in children who weren't in the high-burden group, each infection listed in the diary increased the later risk of moderate to severe infections (AIRR, 1.05; 95% CI, 1.02 to1.08) and systemic antibiotic treatments (AIRR, 1.02; 95% CI, 1.01-1.04). Subtype analyses showed significant associations between each cold, acute otitis media, pneumonia, gastroenteritis, and fever episode between birth and 3 years and increased risk of later moderate to severe infections or systemic antibiotic treatments.
Early infection load and later risks
"This longitudinal cohort study suggests that early-life infection burden may continue throughout childhood and is associated with later antibiotic treatments independent of social and environmental risk factors," the study authors wrote.
The authors also note that, in addition to their findings, other studies have found links between early childhood infection burden and the development of asthma, allergies, cardiometabolic risk factors, and mental disorders later in life.
"It is important for all pediatricians to discuss these disease trajectories associated with early-life infections with families, knowing that a high infection load in the first years of life may increase the risk of infections in later childhood and a range of other chronic disorders later in life," they wrote.
